Today's Date
MM
DD
YYYY
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
*
School or Place of Employment
*
I prefer to be contacted by:
Phone
Email
I prefer to receive newsletter and mail by:
Postal Mail
Email
Driver’s License Number
*
State
*
Have you ever been convicted of a criminal offense?
*
Yes
No
Signature (Type Name)
*
The above information may be verified and I give my permission for inquiry to be made as to my suitability to act as a volunteer for High Horses.
First Name
Last Name
Date
MM
DD
YYYY
Please describe any health or other concerns that you feel would modify your volunteer role. For example, if you are unable to run for too long, or cannot fully support a more physically challenged rider, etc.
(New Volunteers) Do you have experience with horses? If yes, please explain:
Do you have experience working with people with disabilities? If yes, please explain:
(Returning Volunteer) I have been trained by High Horses to:
Sidewalk
Horse Lead
Other
I prefer to be scheduled as a:
Sidewalker
Horse Leader
Any Position
Other
Please notify me for the following trainings:
New Leader
Advanced Leader
Sidewalker
Advanced Sidewalker
Other
Onsite
Barn chores
Tack Cleaning
Site Improvement
Committees
Special Events Committee
Program Maintenance
Grant Writing
Public Relations
Photo Release:
I hereby grant permission to High Horses Center for Equine-Assisted Services the use of photographs, videos, and any other audio/visual media taken of me for promotional materials and publications, educational activities, exhibitions or for any other use for the benefit of the program. I further understand that by signing this release form, I waive any and all present and future rights of compensation or ownership regarding such uses and understand that all materials remain the property of High Horses Center for Equine-Assisted Services.
I certify that I am 18 years of age or older or that my parent or legal guardian has signed below.
I consent to and authorize
I DO NOT consent to nor do I authorize
Date
MM
DD
YYYY
Name
First Name
Last Name